İncesoy Mustafa Alper, Seluk Sefa, Turk Ozgur Ismail, Ezici Atakan, Mert Muhammet, Misir Abdulhamit
Department of Orthopedics, Adiyaman Training and Research Hospital, Yunus Emre Mahallesi, 1164. Sk. No: 13, Adiyaman, Turkey.
Department of Orthopedics, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Rumeli Hisari Sok. No. 62, Baltalimani Sariyer, 34470 Istanbul, Turkey.
Indian J Orthop. 2022 Aug 10;56(11):1958-1968. doi: 10.1007/s43465-022-00708-2. eCollection 2022 Nov.
Muscle and bone morphometry may be potent indicators for predicting femoral subtrochanteric shortening osteotomy (FSSO). We aimed to investigate muscular and bony factors that may be predictive of FSSO.
Patients with unilateral Crowe type 4 developmental dysplasia of the hip (DDH) who underwent unilateral total hip arthroplasty (THA) without (Group 1, 31 patients) and with FSSO (Group 2, 39 patients) were included. Sixty healthy hips (Group 3) were selected as the control group. Several muscular and bony parameters were measured on the operative (O) and non-operative (NO) hips on radiographs and computed tomography (CT) images.
The mean NO gluteus medius cross-sectional area (CSA) index (NO-GMed CI), NO tensor fasia lata (TFL) CI, NO iliopsoas (IP) CI, and NO gluteus maximus (GMax) CI for the control group were lower than those for both Crowe type IV DDH with and without FSSO. The mean NO gluteus minimus CI (NO-GMin CI) for the control group were higher than those for both Crowe type IV DDH with and without FSSO. There was significant difference between Groups 1 and 2 regarding axial position of neo-acetabulum (APNA) (- 0.03 ± 8.5 vs. 5.27 ± 6.33, = 0.004), coronal position of neo-acetabulum (CPNA) (33.39 ± 10.65 vs. 53.70 ± 12.27, = 0.000), operative leg length discrepancy (O-LLD) (14.18 ± 15.14 vs. 24.44 ± 15.80, = 0.001), O-gluteus minimus (GMin) length (155.34 ± 157.73 vs. 106.79 ± 20, = < 0.01), and O-GMin CI (57.28 ± 58.59 vs. 29.95 ± 12.13, = < 0.01). The cutoff values determined by the receiving operating curve analyses were as follows: 13.7 mm, 2.5 mm, and 41.4 mm for O-LLD, APNA, and CPNA, respectively.
FSSO is associated with APNA, CPNA, O-LLD, O-GMin length, and O-GMin CI. By using cutoff values of APNA, CPNA, and O-LLD, predicting FSSO preoperatively is possible. Owing to these parameters, it may be possible to lower the technically demanding level of surgery.
肌肉和骨骼形态测量可能是预测股骨转子下缩短截骨术（FSSO）的有力指标。我们旨在研究可能预测FSSO的肌肉和骨骼因素。
纳入接受单侧全髋关节置换术（THA）且未进行FSSO的单侧Crowe 4型发育性髋关节发育不良（DDH）患者（第1组，31例患者）以及进行了FSSO的患者（第2组，39例患者）。选取60个健康髋关节（第3组）作为对照组。在X线片和计算机断层扫描（CT）图像上测量手术侧（O）和非手术侧（NO）髋关节的多个肌肉和骨骼参数。
对照组的平均非手术侧臀中肌横截面积（CSA）指数（NO-GMed CI）、非手术侧阔筋膜张肌（TFL）CI、非手术侧髂腰肌（IP）CI和非手术侧臀大肌（GMax）CI低于有和没有FSSO的Crowe 4型DDH患者。对照组的平均非手术侧臀小肌CI（NO-GMin CI）高于有和没有FSSO的Crowe 4型DDH患者。第1组和第2组在新髋臼的轴向位置（APNA）（-0.03±8.5对5.27±6.33，P = 0.004）、新髋臼的冠状位位置（CPNA）（33.39±10.65对53.70±12.27，P = 0.000）手术腿长度差异（O-LLD）（14.18±15.14对24.44±15.80，P = 0.001）、手术侧臀小肌（GMin）长度（155.34±157.73对106.79±20，P ＜0.01）和手术侧GMin CI（57.28±58.59对29.95±12.13，P ＜0.01）方面存在显著差异。通过接受手术曲线分析确定的截断值如下：O-LLD为13.7mm，APNA为2.5mm，CPNA为41.4mm。
FSSO与APNA、CPNA、O-LLD、手术侧GMin长度和手术侧GMin CI相关。通过使用APNA、CPNA和O-LLD的截断值，可以在术前预测FSSO。由于这些参数，有可能降低手术的技术要求水平。
